Pharmacology Prep U Chapter 44: Cardiotonic Agents

A nurse caring for a patient with atrial fibrillation who is started on digitalis is required to monitor plasma digitalis levels in the patient's blood. Which plasma level of digitalis indicates that the nurse should report to the practitioner?

2.2 ng/mL

A nurse caring for a patient with atrial fibrillation who is started on digitalis is required to monitor plasma digitalis levels in the patient's blood. Which of the following plasma levels of digitalis indicates that the nurse should report to the practitioner?

2.2 ng/ml

A client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate?

"Take the drug on an empty stomach at the same time each day."

A male client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate?

"Take the drug on an empty stomach at the same time each day."

The nurse monitors which client for an increased risk of digoxin toxicity?

The client with renal dysfunction

A client has an elevated BUN. The client has been prescribed digoxin for heart failure. What aspect of care is the priority regarding this client?

The dose should be decreased in this client. The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity. The client should be taught to limit sodium intake in the diet. The client's heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a client with altered renal function.

Beta-blockers reduce both morbidity and mortality associated with heart failure. By what mechanism do they work in heart failure?

They block the sympathetic response.

Cells of a failing heart due to heart failure often lack the ability to produce the energy needed for effective contraction.

True

Heart failure was once called dropsy.

True

Nesiritide is a human B-type natriuretic peptide.

True

Vasodilators used to treat heart failure include nitrates and ACE inhibitors.

True

A group of nursing students are reviewing cardiotonic drugs. The students demonstrate understanding of the information when they identify which adverse reaction associated with cardiotonic medications?

Visual disturbances

Which of the following is an adverse reaction associated with cardiotonic medications? (Choose one)

Visual disturbances

A nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess?

Yellow or green vision

A nurse assessing a patient on digoxin observes features of toxicity. Which of the following visual disturbances should the nurse assess for in such patients?

Yellow or green vision

A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed?

atropine

A client is being treated for heart failure. Which is most indicative of improved health status?

decreased pitting edema

Your patient has been prescribed inamrinone. You know that this drug works by

increasing cyclic adenosine monophosphate (cAMP).

A client with a history of heart failure is being treated with digoxin. The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart?

positive inotropic effect

Which medication reduces aldosterone-induced retention of sodium and water when prescribed for the treatment of heart failure?

spironolactone

Which dosage forms are used for digoxin (Lanoxin) maintenance therapy? (Select all that apply.)

• Capsule • Injection • Tablet

Administration of a cardiotonic drug is contraindicated in which conditions? (Select all that apply.)

• Digitalis toxicity • Cardiac tamponade • Ventricular tachycardia

Administration of a cardiotonic drug is contraindicated in which of the following conditions? Select all that apply:

• Digitalis toxicity • Cardiac tamponade • Ventricular tachycardia

Cardiotonic drugs are used to treat which medical condition? (Select all that apply)

• Heart failure • Atrial fibrillation

When dosing digoxin (Lanoxin), which factors are considered? (Select all that apply.)

• Patient lean body weight • Patient age • Renal function • Pharmacokinetics • Pharmacodynamics

When dosing digoxin (Lanoxin), which of the following factors are considered? Select all that apply:

• Patient lean body weight • Patient age • Renal function • Pharmacokinetics • Pharmacodynamics

What is the most accurate method for preventing adverse effects associated with the use of digoxin?

Assess the patient's heart rate and hold administration if it is less than 60.

When caring for a patient who has been digitalized for his heart failure, the nurse observes that the patient is experiencing bradycardia. Which of the following drugs should be administered to patients who develop bradycardia?

Atropine

A patient is prescribed a cardiotonic medication. Which of the following pre-administration assessments should the nurse perform on this patient?

Check for jugular vein distention.

The home care nurse sees a patient for the first time. The patient has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the patient experiencing?

Congestive heart failure

A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which nursing diagnosis would be appropriate for this patient?

Decreased Cardiac Output related to altered cardiac function

A patient is being treated for heart failure. Which of the following is indicative of improved heart failure status?

Decreased pedal edema

Which would the nurse identify as a cardiac glycoside?

Digoxin

A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which of the following medications will be administered?

Digoxin immune fab (Digibind)

The nurse should assess for what as a symptom in a client with left-sided heart failure?

Dyspnea Symptoms of left-sided failure include dyspnea and moist cough. Edema, hepatic engorgement, and distended neck veins are symptoms of right-sided failure.

The nurse is teaching a female patient about newly prescribed digoxin. The patient tells the nurse that she occasionally uses herbal therapies. The nurse should caution the patient against using therapies that involve which herbs?

Ginseng

Which adverse effect might occur in a client receiving milrinone?

Hypotension

Which would be considered a therapeutic effect of digoxin?

Increased force of contraction

The pharmacology instructor is discussing cardiac glycosides with a class of pre-nursing students. According to the instructor, what physiologic effect do cardiac glycosides trigger?

Increased force of heart contraction

The nurse explains to the client that with heart failure, what may occur?

Increased heart rate

The nursing instructor explains to students that positive inotropic action affects the heart in which way?

Increased myocardial contraction

A nurse is preparing to administer inamrinone. The nurse would administer this drug most likely by which route?

Intravenous

The client's digoxin level is 0.125. How does the nurse interpret this level?

Low

The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema?

Measurement of intake and output

The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take?

Notify the physician

You are caring for a 66-year-old female client who is receiving digoxin. When preparing to administer a dose, you observe that the client's apical pulse rate is 55 bpm. What is the appropriate action to take?

Omit the dose and contact her physician.

A nurse is caring for a 66-year-old female client who is receiving digoxin. When preparing to administer a dose, the nurse observes that the client's apical pulse rate is 55 bpm. What is the appropriate action to take?

Omit the dose and contact the health care provider.

A nurse is required to monitor a client for right ventricular dysfunction. Which would the nurse most commonly assess?

Pitting edema

A nurse is required to monitor a patient for right ventricular dysfunction. Which of the following is one of the most common symptoms associated with right ventricular dysfunction?

Pitting edema

A client is receiving inamrinone. Which of the following would be most important for the nurse to monitor?

Platelet count

A patient with a history of congestive heart failure is being treated with digoxin (Lanoxin). This medication increases the force of contractions of the heart. What effect improves the contractility of the heart?

Positive inotropic effect

A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be most important for the nurse to monitor?

Potassium levels

A nurse is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the nurse to monitor?

Potassium levels

After teaching a group of students about conditions that can lead to heart failure, the instructor determines that additional teaching is needed when the students identify which of the following?

Renal failure

Which condition would least likely contribute to the development of heart failure?

Renal failure

Clients on digoxin need to have their digoxin level monitored. The nurse identifies the therapeutic range for digoxin as which of the following?

0.8 to 2 ng/mL

The nurse identifies the therapeutic range for digoxin as:

0.8 to 2 ng/mL

A patient is receiving digoxin. The nurse monitors the patient's digoxin level. Which finding would the nurse interpret as therapeutic?

1.5 ng/mL

A nurse must immediately report serum digoxin levels greater than? (Choose one)

2.0 nanograms/mL

A nurse obtains the serum digoxin level and immediately reports a level greater than which value?

2.0 ng/mL

Which would a nurse expect to assess if a client is experiencing right-sided heart failure?

Peripheral edema

Which of the following would the nurse identify as a cardiac glycoside?

Digoxin

A patient has an elevated BUN. The patient has been prescribed digoxin (Lanoxin) for heart failure. What factor is important regarding this patient?

The dose should be decreased in this patient.

Digoxin has been prescribed for an outclient with symptomatic heart failure. What is the priority teaching point to convey to this client?

"Make sure to take your pulse for a minute before taking your digoxin." Clients should measure their heart rate for a full minute before taking a dose of digoxin. The drug can be taken with food, and potassium intake should be increased, not decreased. The client's daily dose of digoxin should never be increased in response to short-term changes in symptoms.

A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained?

3.5-5.0 mEq/L

A male client states that he is seeing halos around lights. The client takes digoxin (Lanoxin) by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity?

4.0 nanograms per milliliter

A patient states that he is seeing halos around lights. The patient takes digoxin (Lanoxin) by mouth every day. The physician orders the patient to have serum digoxin level drawn. Which of the digoxin levels indicate the patient is experiencing toxicity?

4.0 nanograms per milliliter

A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame?

5 minutes

Which of the following assessment findings may indicate the client is experiencing digitalis toxicity? Select all that apply.

Abdominal pain • Diarrhea • Drowsiness • Vomiting

After reviewing the signs and symptoms of heart failure, a student demonstrates understanding when the student identifies which finding as associated with right sided heart failure?

Peripheral edema

Which of the following would a nurse expect to assess if a client is experiencing right-sided heart failure?

Peripheral edema

A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the health care provider to order what medication to treat the bradycardia?

Atropine

A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the physician to order what medication to treat the bradycardia?

Atropine

When caring for a patient who has been digitalized for his heart failure, the nurse observes that the patient is experiencing bradycardia. Which drug should be administered to patients who develop bradycardia?

Atropine

A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which of the following nursing diagnoses would be appropriate for this patient?

Decreased Cardiac Output related to altered cardiac function

Your client is being treated for hypokalemia. His current medications include Inderal, digoxin, and Coumadin. He is complaining about nausea, abdominal discomfort, and visual changes. Which of the following problems would you suspect?

Digitalis toxicity

What conclusion should the nurse draw when a client's digoxin level is reported to be 2.2 ng/mL?

Digitalis toxicity is a possibility.

Your client's digoxin level is reported to be 2.2 ng/mL. You know that this result indicates:

Digitalis toxicity.

A nurse is planning an in-service program for a group of staff nurses about heart failure and its treatment. The nurse would identify which agent as the most commonly used drug for treatment?

Digoxin

After teaching a class of students about heart failure and drug therapy, the instructor determines that the teaching has been successful when the students identify which drug as most often used as treatment?

Digoxin

Which of the following is to treat a massive digoxin overdose? (Choose one)

Digoxin immune Fab (Digibind)

A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which drug?

Digoxin immune fab

A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which medication will be administered?

Digoxin immune fab (Digibind)

You are teaching a patient about her newly prescribed digoxin. The patient tells you that she occasionally uses herbal therapies. You should caution the patient against using therapies that involve which of the following herbs?

Ginseng

Milrinone (Primacor) is a miscellaneous inotropic drug used in the short term management of heart failure. What is the only way this drug is approved to be administered? (Choose one)

Intravenously

Milrinone (Primacor) is a miscellaneous inotropic drug used in the short-term management of heart failure. What is the only way this drug is approved to be administered?

Intravenously

The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which of the following interventions should be taken to alleviate edema?

Measurement of intake and output

The nurse is preparing to administer digoxin to a 9-month-old infant. What must the nurse do prior to administration of this medication?

Monitor the infant's apical pulse

The pharmacology instructor is describing medications that increase the contractile force of the heart. Which of the following terms describes this effect?

Positive inotropic

The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect?

Positive inotropic

A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which instructions should the nurse provide the patient on discharge?

Take the drug regularly without skipping a dose.

A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which of the following instructions should the nurse provide the patient on discharge?

Take the drug regularly without skipping a dose.

A triage nurse in the emergency department suspects that a 78-year-old patient is experiencing severe digoxin toxicity with significant cardiac dysrhythmia. If she is correct, which of the following actions is likely to be taken?

The patient will be given digoxin immune fab.

A triage nurse in the emergency department suspects that a 78-year-old patient is experiencing severe digoxin toxicity with significant cardiac dysrhythmia. If the nurse is correct, which action is likely to be taken?

The patient will be given digoxin immune fab.

What assessment should the nurse perform on a daily basis when a client is prescribed furosemide?

body weights

A nurse has poured a hospital client's scheduled dose of hydrochlorothiazide (HCTZ). The nurse should know that this drug reduces preload by which means?

increasing renal excretion of sodium and water Hydrochlorothiazide inhibits the reabsorption of sodium and chloride in the distal renal tubule, increasing the excretion of sodium and water by the kidneys. Thiazide diuretics do not relax smooth muscle, increase contractility, or stimulate the SA node.

A client presents to the ED with wheezing and blood-tinged sputum. The nurse suspects the client is experiencing pulmonary edema. The nurse should suspect the cause of the pulmonary edema is most likely:

left ventricular failure Pulmonary edema occurs when left ventricular failure (or dysfunction) results in accumulation of blood and fluid in pulmonary veins and tissues.

To maximize absorption of digoxin, the nurse would instruct the patient to take the drug:

on an empty stomach

A client, newly diagnosed with heart failure, questions why the therapy with digoxin will begin with four doses of digoxin rather than the usual one dose, in a 24-hour period. What is the rationale for the nurse's response?

to rapidly bring the client's serum digoxin levels up to therapeutic levels